Learning from the Coordinated Chronic Disease Project
During my time in the public sector, I observed many stakeholder engagement processes that went really well and led to meaningful change. Unfortunately, I also process observed like this:
Participants arrive. They have been told it’s an opportunity to provide input to an important planning process. After listening to a 20 minute presentation, audience members sign up to share their input. In three minute comments, audience members rush to get to their main point, largely focusing on their strongly held views. As the staff listen, they feel exhausted by the idea of bridging all these conflicting priorities. The information is mostly left unused in the final plan.
This week’s blog highlights a real life example on how to put your stakeholder engagement process successfully into action so you never have to sit through or participate in a process like the one described above.
Tips to Make your Stakeholder Engagement Efforts Successful
In my last blog, I thought I could do this on my own: Why engaging stakeholders throughout your initiative is so important, I shared what stakeholder engagement is and why it is important. I also offered four tips to make your stakeholder engagement process successful, including defining your stakeholders early in the process, developing a stakeholder engagement plan, developing a communication plan, and using a high-quality facilitator. Please keep your eye out for our upcoming checklist that has a bit more detail about each tip and how to put them into action.
Making it Happen – The Coordinated Chronic Disease State Framework
In 2012, Spark implemented a stakeholder engagement process to develop the Coordinated Chronic Disease State Framework, an initiative led by the Colorado Department of Public Health and Environment. Here’s how we did it:
The stakeholders were identified. We worked collaboratively with CDPHE to identify a broad range of stakeholders at the state and local level. The stakeholders included local public health, higher education, health care providers and associations, community organizations, state agencies, advocacy organizations, provider and family members, board members, funders, and researchers.
A stakeholder engagement plan was developed & implemented. We used a two-pronged approach by hosting seven community forums and convening a State Advisory Team. Over 125 stakeholders attended forums in Montrose, Frisco, Denver, Sterling, La Junta, Alamosa, and Durango. They and the Advisory Team gained a deeper understanding of a coordinated chronic disease approach, provided input on themes and approaches from the community forums and prioritized strategies to include in the framework.
A communication plan was developed and implemented. We partnered with the CDPHE Health Communications Unit to develop messages and materials to reach our stakeholders. A monthly newsletter was distributed, meetings were broadcast and archived on-line, a webpage was created on CDPHE’s website, and messages were sent out through Twitter and Facebook.
All meetings were facilitated thoughtfully. Our staff facilitated the community forums and State Advisory Team meetings. Our approach to facilitation established trust and engaged all members. For community forum participants, this was their experience:
Participants arrive and have been told that the state is seeking to develop a coordinated approach to chronic disease programming. After listening to a presentation on CDPHE’s chronic disease efforts and a cross-walk of state chronic disease plans, participants self-select into small groups. The groups discuss their vision for the coordination of the chronic disease programming and discuss action steps in five domain areas (community-clinical linkages, health systems, policy and environmental changes, education and communications, and data surveillance). Each group reported their small group discussions out to the large group. They are told how their information will be used by CDPHE and the State Advisory Team before adjourning.
Not every stakeholder participation process is going to look just like my example here. Every situation is different, and every set of stakeholders in a particular issue will have their own challenges to face. But I’m hoping that by telling you this story – about how we’ve engaged stakeholders about the Coordinated Chronic Disease State Framework – you might see not only how the change you seek might be advanced by engaging your stakeholders thoughtfully, but also how to accomplish that engagement.
- Community Toolbox Stakeholder Engagement Tools: The Community Tool Box is a big fan of participatory process. That means involving as many as possible of those who are affected by or have an interest in any project, initiative, intervention, or effort. In this section, they discuss how to find and involve the right stakeholders and respond to their needs.
- Brochures on Public Involvement, Environmental Protection Agency: Due to extensive mandates requiring public involvement in environmental processes, the EPA has provided many tools on their website for engaging a broad range of stakeholders. In particular, the brochures are relevant to engaging the public on any issue. They provide steps and information on budgeting for public involvement, identifying people to involve, technical assistance, outreach, using public input, evaluating public involvement, improving public meetings, and overcoming barriers.
Braided funding is when you use multiple funding streams utilized to pay for all of the services needed by a given population, with careful accounting of how every dollar from each funding stream is spent. This blog will introduce you to a “Coordinated Finance Plan” – a tool for designing a braided funding approach that is streamlined and audit-ready.
What is a Coordinated Financing Plan?
A coordinated financing plan is:
- A tool for talking with your funders so they can clearly understand the design of your braided system.
- A tool to help your programmatic staff, your fiscal staff, and your board understand how and why each decision is being made.
- A method for increasing the likelihood that every dollar of your funding is being used appropriately, including that blending or braiding multiple funding streams will not result in supplanting.
Part 1: The Program Budget and Cost Allocation
The program budget is the easy part. But what’s a cost allocation plan? This is the tool that will bring your budget to life and turn it into a braided or blended model.
- If you are blending your funding, the cost allocation plan is a static budget that you can set in advance. Your priority will be to make sure you track sufficient information on eligibility and outcomes to report back to your funders.
- If you are braiding your funding, the cost allocation plan is a flexible budget and accounting tool that tracks spend down across your funding streams.
Cost allocation plans in a braiding context are living documents that begin with estimations, but help you keep track of how you can flexibly allocate resources to meet monthly needs, based on eligible populations and services. In essence, the cost allocation plan provides you with upfront information to ensure you can cover all your expenses across all your funding streams and ongoing information on the progress of spending down your funding streams.
Want a tool to help you design your cost allocation plan? Go to: http://sparkpolicy.com/fiscalguides.htm#Guide1. Our team also has experience helping with this, so feel free to give us a call: 303-455-1740.
What does a Front Door/Back Door have to do with finances?
Just as in a grocery store, your program has a door people come through on their way in, and another one they exit on the way out. In a program, that backdoor is also where decisions are documented about the finances will be spent. Let’s break this down:
At the Front Door, you will be identifying how eligibility and allowability are determined.
- Eligibility refers to the clients who will be eligible for some or all of the services provided by your blended or braided model.
- Allowability refers to the services that each client will be allowed to receive, based on their eligibility.
Questions to answer when you design the front door of your program include things like:
- Who is responsible for determining eligibility? In other words, who has the tools and authority to decide whether a client should be accepted in your program?
- Who is responsible for determining allowability? In other words, who has the tools and authority to decide which services are options for a new client in your program?
- What is the protocol for turning clients away? In other words, what referrals or other supports can you offer as you reject a client who does not meet your criteria for eligibility?
- How will you document eligibility and allowability? Where will the documentation live and when and how will it be used to make decisions along the way?
At the Back Door, you will be identifying how allocation of costs to funding streams will be determined. The Back Door is responsible for making sure that all allowable services are paid for by appropriate funding streams, with appropriate services as defined by the eligibility and allowability of the clients. Additionally, the Back Door is responsible for maintaining appropriate spend-down across the funding streams, using a protocol designed to guide them. The protocol should also help the Back Door staff understand which funding streams to use first.
Some of the questions to answer when you design the back door of your program include things like:
- Which funding streams need to be spent down steadily?
- Which funding streams should be used whenever possible?
- Which funding stream should be used as a last resort?
Yes, this is where we discuss everyone’s favorite thing to do – document, document, document. While tracking how time and money are used is not a fun thing, it also doesn’t have to be as painful as we sometimes make it.
One of the critical components to a successful braided model, particularly a model that includes funding streams that fall under the federal OMB Circular A-87 (see Appendix A of the fiscal guide, link below), is to track personnel time by eligible populations/allowable services. To ensure the Back Door has enough information to allocate staff time to appropriate funding streams, all of the staff paid for through the braided model should keep time sheets that indicate the case ID of the client served and time spent on that client. If a staff person engages in non-service delivery activities, the staff person should also have a place on their timesheet for the major categories of activities, defined by what is allowable across the funding streams.
While you need this type of tracking system, one of the best things you can do for yourself is to create a system that is:
(1) As simple as you can get away with, only collecting exactly what you need to know. For example, if staff is tracking time spent, have them use a checkbox of options instead of open-ended notes. This simplifies for both the staff tracking time and the staff using the information for billing purposes.
(2) As flexible as possible, not programmed into rigid databases and complex accounting systems. Funding streams can and will change over time, whether due to your existing funding streams changing regulations or new funding streams being secured. Don’t create a system that is difficult to change over time. Be flexible, use easy to adapt tools like Excel, Word, Adobe Forms, Google Forms, etc.
You also need to keep track of your money – setting up your financial systems to have the same categories as those that your funders require you to report. Make sure your financial system aligns as closely as possible with your Front Door and Back Door plans. Don’t create any extra complexity in anything you do.
Want more information on how to build your front door and back door models and keep track? Visit: http://sparkpolicy.com/fiscalguides.htm#Guide1.
Align, Simplify, and be Flexible.
If you take nothing else away from this blog, remember these three terms and apply them to how you braid multiple funding streams. Align activities throughout your program, from how program staff check and document eligibility to how financial staff report to funders and track in their accounting systems. This will simplify everyone’s experience, from program staff to administrators to support staff. Don’t use rigid tools that make it hard to change and adapt with time – always remain flexible.